19 Sep Conservative versus Invasive Management: Is It Time?
The spine consists of 7 cervical vertebrae in the neck, 12 thoracic vertebrae in the upper back, 5 lumbar vertebrae in the lower back, 5 sacral vertebrae in the sacrum, and another 4 coccygeal fused vertebrae in the tailbone. The spine has an important function as it supports the entire body and helps with movement. It also protects the spinal cord and the discs between each vertebrae function as shock absorbers. Since the spine is a crucial part of the body, any issues that involve it can affect all activities of daily living.
Almost all individuals who suffer from spinal problems at some point in life. Symptoms may include pain, numbness, tingling, or even weakness in the affected limb. The goal of treatment is aimed towards symptomatic relief and prevention of any neurologic consequences. There are many options for conservative therapy. For example, physical therapy and rehabilitation have been proven to have helped the majority of patients with symptomatic relief. It includes strengthening exercises that can prevent future episodes or recurrence of similar problems. Other conservative measures include oral medication that helps with pain relief, heat therapy, ice therapy, injections with, and more.
So, when is it time for invasive management? Invasive management means surgery for patients. Surgical treatment is indicated when signs and symptoms do not improve with conservative therapy after a certain duration, usually six weeks. It is also the go-to treatment in emergencies when there is debilitating pain or significant compression of the nerves. One good example is the cauda equina syndrome where the compression of nerves causes the loss of control of the bladder and bowels, weakness of the lower limbs, gait disturbance, and more.
Outcomes & Statistics
Is there a difference of outcomes between conservative and invasive treatment options? Many studies have been done to compare the effectiveness between conservative and surgical management for intervertebral disc herniations, spinal stenosis, and degenerative spondylolisthesis.
- A study by the Spine Patient Outcomes Research Trial (SPORT) found that surgery has a better outcome after a period of 4 years compared to conservative schedule.
- The North American Spine Society (NASS) in its guidelines suggests that patients with pain (3-36 months) can achieve pain-relief by using multiple injection regimens of injections that is performed on demand or when the pain has exceeded a certain level. A study found that an epidural injection with lidocaine or in combination with a corticosteroid is significantly effective to help with pain and improves function in patients.
- There are also many different types of surgical procedures available for each different spinal condition. For example, a study found that spinous process osteotomy, bilateral laminotomy, and unilateral laminotomy with crossover to be effective in treating patients with lumbar spinal stenosis.
In conclusion, conservative management is always the first line of treatment for all patients with spinal issues except in emergency cases. However, surgery is considered if there is no improvement after conservative management has failed or in cases where symptoms are debilitating to the quality of life.
- Hsiang JK. Spinal stenosis treatment and management. Medscape. Accessed 6/30/2017.
- Ullrich PF. Conservative vs surgical care for lower back pain. Spine Health. Accessed 6/30/2017.